Wednesday, May 13, 2020

It is well established that early
identification and intervention are critical determinants in the course and
outcome of autism spectrum disorder (ASD). Although there are no
“absolute” clinical indicators of autism, some of the early “red flags”
include: • Does not smile by the age of six months • Does not respond to his or
her name • Does not cry • Does not babble or use gestures by 12 months and •
Does not point to objects by 12 months. Children with autism typically
experience delays in speech and communication skills. Not only will they often
develop spoken language later, but they are less likely to develop non-verbal
communication skills such as “joint attention,” pointing, or gesturing.

Social Communication Skills

Young children with autism
spectrum disorder (ASD) typically exhibit core deficits in social communication
skills, particularly in the areas of joint attention, shared affect,
eye-contact, conventional and symbolic gestures, and related skills in
functional and symbolic play. Children seek to share attention with others
spontaneously during the first year of life. “Joint attention” is an
early-developing social-communicative skill in which two people (usually a
young child and an adult) use gestures and gaze to share attention with respect
to interesting objects or events. Before infants have developed social
cognition and language, they communicate and learn new information by following
the gaze of others and by using their own eye contact and gestures to show or
direct the attention of the people around them. These developments in the first
two years of life are potentially important early indicators of ASD which can
facilitate earlier diagnosis. Researchers have identified five core deficits
(‘red flags’) evident in the early years, namely gaze shifting, gaze point following,
rate of communicating, joint attention and gestures; these were the strongest
predictors of symptoms of autism at three years of age.

Research

Researchers in Melbourne
Australia, working on a long-term study of children from eight months to seven
years of age found that those with autism used fewer gestures to communicate
than other kids. Parents of 1,911 children participating in the ‘Early Language
in Victoria Study’ in Melbourne, Australia, completed questionnaires about
their child’s development from infancy through to school age. At four years of
age, a group of children identified with an autism spectrum disorder (ASD) were
compared to other children from within the study; those with a developmental
delay, language impairment, or typical development. Comparisons were made
between the children’s early social communication skills (including eye-gaze,
non-verbal communication, gesture, and speech skills) at 8 months, 1 year, and
2 years of age. By one year of age, children with ASD used fewer early social
communication skills than children with typical development. The only social
communication skill that was found to be significantly different between
children with ASD and all other children, however, was the use of gesture.
Children with ASD used fewer gestures for communication than all other children
at both 1 and 2 years of age.

Implications

Speech pathologist Carly
Veness, who led the research, said there was a pattern of low gesture use among
autistic children between the ages of eight months and two years. "We
found that there was a decreased use of gestures like pointing, showing and
giving,” she commented. The researchers noted that gestural deficits almost
doubled the risk for ASD, pointing to the importance of targeting gesture
deficits in infant early intervention approaches. They conclude that their
results “… highlight the possibility of detecting risk signs for ASD as young
as 12 months of age in a community sample, thus allowing for earlier
recognition of the disorder.”

Tuesday, May 5, 2020

Challenging behavior is any behavior that interferes
with a child’s learning, engagement, and social interactions with her peers or
adults. Aggression is often observed as one form of challenging behavior in
autism. Although aggression is not itself a symptom of autism and not all autistic
individuals are aggressive, research suggests that rates of challenging behavior
may be higher in individuals with autism compared to typically developing peers
and those with other developmental disabilities. Children with autism don’t necessarily express anger, fear,
anxiety or frustration in the same way as other children. However, irritability
is a symptom of autism that can complicate adjustment at home and other
settings, and can manifest itself in aggression, tantrums, and self-injurious
behavior.

Behavior as Communication

Children
engage in problem behavior to communicate. The principles of behavior teach us that it does
not occur in a vacuum – that is, behavior does not occur without regard to the
context in which it is observed. When working with autistic children we should consider problem behavior as a communication
attempt, and should determine what skill the child needs to learn in order to
reduce the need for the problem behavior or what environmental modification
makes the behavior unnecessary.The first step to developing an
effective intervention strategy is to identify the function of
the behavior. By function, we mean what the child is trying to access by
engaging in the challenging behavior. In other words: you first must figure out
what it is the child is trying to communicate. For example, a student might exhibit challenging behaviors
with the goal of escape or the goal of seeking attention. When the curriculum
is difficult or demanding, they may attempt to avoid or escape work through
challenging behavior (e.g., refusal, passive aggression, disruption, etc.).
Similarly, they may use challenging behavior to get focused attention from
adults and peers, or to gain access to a preferred object or participate in an
enjoyable activity. Problematic behavior may also occur because of sensory
aversions. Because autistic students also have significant social and pragmatic
skills deficits, they may experience difficulty effectively communicating their
needs or influencing the environment. Thus, challenging classroom behavior may
serve a purpose for communicating or a communicative function.

Common Triggers

Research suggests that common triggers include disturbing breaks in routine, lack of sleep, jarring “sensory stimuli” (noises, lights, or smells) or even undiagnosed mental health problems. Children with significant aggressive behavior also tended to have mood and anxiety symptoms, and difficulty sleeping and paying attention. Clearly, it’s important to look beyond the behavior itself to identify the underlying cause or trigger.Children with significant aggressive behavior also tended to have mood and anxiety symptoms, and difficulty sleeping and paying attention.The studies also indicate that symptoms of aggression often overlap in patients with extreme anxiety and attention deficit issues.It has been reported that executive function deficits (e.g. issues with inhibition, working memory, planning and flexibility) are associated with anxiety and aggression in autism and may serve as a pathway to comorbid psychopathology (sensory stimuli, a change in routine, transition between activities, or physical reasons like feeling unwell, tired or hungry. Not being able to communicate these difficulties can lead to anxiety, anger and frustration, and then to an outburst of challenging behavior. Comorbidity

Children with autism experience a number of related difficulties, including sleep problems, gastrointestinal (GI) problems, sensory issues, and self-injury. Many of these problems have been associated with aggression among typically developing children, and emerging evidence suggests a similar relationship in children with autism. For example, sleep problems occur in a large percentage of autistic children, with prevalence rates ranging from 50% to 80%. Sleep problems have been found to be highly associated with aggression in typically developing children. Likewise, research suggests that children with autism and sleep problems are more likely to demonstrate aggression than those without sleep problems.

Sensory problems, including sensory over-responsivity, sensory under-responsivity, and sensory seeking are also common problems in autistic children. In typical children, sensory problems have been associated with aggressive and externalizing behavior problems. Similarly, recent studies have been found correlations between sensory problems and broadly defined externalizing problem behaviors in autistic children. However, research has yet to specifically examine the potential contributing role of sensory problems in predicting physical aggression.Self-injurious behavior also appears to be relevant to the occurrence of aggression. Individuals with autism are at an increased risk for demonstrating self-injurious behaviors, as compared to those without autism, with prevalence rates ranging from 30% to 53%. Although self-injury and other forms of challenging behaviors have been considered to be distinct forms of behavior, they are often related. For example, physical aggression and self-injury have been significantly associated among individuals with severe intellectual impairment and there is evidence that self-injurious behaviors are precursors of later aggression in this population. However, similar studies have not investigated the relationship between self-injury and physical aggression in autistic children.

Lastly, gastrointestinal (GI) problems may also have relevance to the occurrence of aggression. GI problems are common in autistic children, with prevalence rates ranging from 24% to 70% or higher, depending on symptom definitions. Although there some evidence of an association between behavior problems and GI problems, a population-based study of autistic children did not find significant differences in aggression when comparing children with and without GI problems.

Predictors

Although the nature and developmental course of aggression have been a focus of research with typically developing populations, there have been few large-scale studies of group-level predictors of aggression among individuals with autism. Consequently, it is unclear whether findings from the general population are applicable to autistic children and adolescents. In an effort to investigate the extent of the problem in children and adolescents with autism, a recent large-scale study published in Research in Autism Spectrum Disorders examined the prevalence and correlates of physical aggression in a sample of 1584 children and adolescents with ASD enrolled in the Autism Treatment Network (ATN), a multi-site network of 17 autism centers across the US and Canada. The results indicated that the prevalence of aggression was 53% across the entire sample of children, with highest prevalence among young children. These results are highly consistent with recently reported prevalence rates (56%) in another large-scale study of children and adolescents with autism. The results also indicate that age-related decreases in aggression in autistic children are similar to what has been observed in typically developing children. It should be noted, however, that a large percentage (nearly 50%) of the adolescents in the study’s sample continued to demonstrate physical aggression. Thus, the relative decrease in aggression over time must be balanced by the finding that these behaviors continued to occur at a high rate among a large portion of adolescents with autism.

In terms of predictors, the results indicated that self-injury was highly associated with aggression among children with autism. This is consistent with the findings of other studies showing a strong association between self-injury and other challenging behaviors. The current results add to existing literature, and suggest that autistic children who demonstrate self-injury may be at risk for more severe behavioral problems.

Sleep problems emerged as a second significant predictor aggression. This association between sleep problems and aggression is largely consistent with previous findings among both typically developing children and those with autism, indicating may underlie (and exacerbate) aggressive behavior patterns for many autistic children. It should also be noted that sleep problems have been found to be associated with self-injurious behaviors among individuals with intellectual disabilities and that these two conditions may be related. In fact, there is some developing evidence suggesting shared neurobiological basis for both sleep disturbance and self-injurious behavior.

Sensory problems were also significantly associated with aggression. These findings are consistent with similar associations between sensory issues and aggression among typically developing children. While previous research has demonstrated an association between sensory problems and broadly defined behavior problems, the current results extend these previous findings by demonstrating a specific relationship between sensory problems and physical aggression.

Comparisons also indicated that children with aggression were more likely to experience GI problems, communication skill difficulties, and social skills difficulties. However, these variables did not appear as significant predictors of aggression, indicating that self-injury, sleep problems, and sensory issues accounted for the majority of the variance in predicting aggression.

In regards to potential sex differences, the results indicate that girls and boys with autism were equally likely to engage in aggression. This finding was unexpected in that research has consistently shown a significant gender difference among children without autism, with boys being much more likely to engage in physical aggression than girls. The results of the study suggest that the sex differential in aggression may not be salient in the autistic population.

Implications

This study provides evidence that challenging behavior may be much more prevalent among children with autism than in the general population and that some comorbid problems may place individuals at risk for aggression. Aggression was significantly associated with a number of clinical features, including self-injury, sleep problems, sensory problems, GI problems, and communication and social functioning. However, self-injury, sleep problems, and sensory problems were most strongly associated with aggression. These findings indicate that co-occurring problems specific to the autism phenotype may play an important role in the occurrence of aggression and that it is important to consider multiple domains of functioning when assessing and treating aggression in autistic children. For example, increased attention should be given to the identification and treatment of sleep problems, self-injury, and sensory problems. Given the significant relationship between sleep problems and aggression, it is possible that treatments targeting sleep problems may help reduce maladaptive behavior. Thus, assessment and treatment of sleeping problems might be included as a standard and integrated part of the assessment and treatment of autism. Programs for children with autism should also integrate an appropriately structured physical and sensory milieu in order to accommodate any unique sensory processing challenges. Behavioral interventions, particularly those
based upon applied behavior analysis (ABA), have long had empirical support for
addressing problematic behavior (for a review, see Schreibman, 2000). A
comprehensive treatment plan for treating aggressive behaviors in children with
autism begins with a precise and thorough assessment, followed by implementation
of a comprehensive treatment plan.Although assessment tools are limited, comorbid problems should be assessed whenever significant behavioral issues (e.g., inattention, mood instability, anxiety, sleep disturbance, aggression) become evident or when major changes in behavior are reported. Co-occurring disorders should also be carefully investigated when severe or worsening symptoms are present that are not responding to traditional methods of intervention. It is important to take the time to analyze these underlying
causes of aggressive behavior in children with autism. By understanding the
triggers of aggression, we are able to choose the most effective
intervention strategies. Once we understand the function or goal of student behavior, we can begin to teach alternative replacement behavior and new interaction skills. Further research is needed in order to better understand the characteristics and course of different types of aggression. For example, future research should examine the longitudinal course of aggression, the role of these associated problems in predicting improvement or worsening of aggression, and possible changes in aggression in response to treatment for these co-occurring problems. Studies are also needed to examine the role of additional family- and community-level variables in the prediction and maintenance of aggression among children with autism.

Sunday, April 26, 2020

There is robust research to suggest that 70 to 80
percent of children with autism spectrum disorder (ASD) meet diagnostic criteria for one or more
co-occurring (comorbid) disorders and 40 to 50 percent meet criteria for two or
more. A Comorbid
disorder is defined as a condition that co-occurs with another diagnosis so
that both share a primary focus of clinical and educational attention. The most
prevalent comorbid conditions are anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems, and
chronic tic disorders, all which contribute to overall impairment.

Internalizing Problems

Studies have consistently
reported an association between ASD and internalizing symptoms, in particular,
anxiety and depression. A bidirectional association has been identified between
internalizing disorders and autistic symptoms. For example, both a higher
prevalence of anxiety disorders has been found in ASD and a higher rate of
autistic traits has been reported in youth with mood and anxiety disorders. Although
prevalence rates vary from 11% to 84%, most studies indicate that approximately
one-half of children with ASD meet criteria for at least one anxiety
disorder. Individuals with ASD also display more social anxiety symptoms compared to
typical individuals, even if these symptoms were clinically overlapping with
the characteristic social problems of ASD. In addition, there is some evidence
to suggest that adolescents and young adults with ASD show a higher prevalence
of bipolar disorders as compared to controls.

Depression is one of the
most common comorbid conditions observed in individuals with ASD, particularly
higher functioning youth. A study of psychiatric comorbidity in young adults
with ASD revealed that 70% had experienced at least one episode of major
depression and 50% reported recurrent major depression. Although another
documented association is with obsessive-compulsive disorder (OCD), it is
difficult to determine whether observed obsessive-repetitive behaviors are an
expression of a separate, comorbid OCD, or an integral part of the core
diagnostic features of ASD (i. e., restricted, repetitive patterns of behavior,
interests, or activities).

Externalizing Problems

An association between ASD
and attention-deficit/hyperactivity disorder (ADHD) and other externalizing
problems (i. e., oppositional defiant disorder) have been reported. Studies
have found that children with ASD in clinical settings present with
co-occurring symptoms of ADHD with rates ranging between 37% and 85%. Although
there continues to a debate about ADHD comorbidity in ASD, research, practice
and theoretical models suggest that co-occurrence between these conditions is
relevant and occurs frequently. For example, case studies suggest that ADHD is
a relatively common initial diagnosis in young children with ASD. It is also
important to note that a significant change in the DSM-5 is removal of the
DSM-IV-TR hierarchical rules prohibiting the concurrent diagnosis of ASD and
ADHD. When the criteria are met for both disorders, both diagnoses are given.

Other Comorbidities

Tourette Syndrome (TS) and
other tic disorders have been found to be a comorbid condition in many children
with ASD. A Swedish study showed that 20% of all school-age children with ASD
met the full criteria for TS. There also appears to be a higher incidence of
seizures in children with autism compared to the general population. The
comorbidity of ASD and psychotic disorders has received some research
attention. A study of children with ASD who were referred for psychotic
behavior and given a diagnosis of schizophrenia showed that when psychotic
behaviors were the presenting symptoms, depression and not schizophrenia, was
the likely diagnosis. Thus, individuals with ASD may present with
characteristics that could lead to a misdiagnosis of schizophrenia and other
psychotic disorders. Other co-occurring
conditions include physical(cerebral palsy, atypical gait), and
medical (allergies, asthma, gastrointestinal) conditions. Behavior
problems associated with GI distress may include sleep
disturbances, stereotypic or repetitive behaviors, self-injurious behaviors,
aggression, oppositional behavior, irritability or mood disturbances, and
tantrums. In addition, unusual responses to sensory stimuli, chronic sleepproblems, catatonia, and low muscle tone often occur in individuals with ASD. Specific learning difficulties are also common, as is
developmental coordination disorder.

Implications

Many individuals with ASD have symptoms that do
not form part of the diagnostic criteria for the disorder (about 70% of
individuals with ASD may have one comorbid disorder, and 40% may have two or
more comorbid conditions). The most common co-occurring
diagnoses are anxiety and depression, attention problems, and challenging behavior
disorders. When the criteria for a comorbid disorder is met,
both diagnoses should be given. Medical conditions commonly associated with ASD
should also be noted.The core symptoms of ASD can often mask the symptoms of a comorbid
condition. The challenge for practitioners is to determine if the
symptoms observed in ASD are part of the same dimension (i. e, the autism
spectrum) or whether they represent another condition. Although various
psychometric instruments, such as clinical interviews, self-report
questionnaires and checklists, are widely used to assist in diagnosis, these
tools are designed and standardized to identify symptoms in the general
population, and may not be appropriate and valid for use with ASD. Likewise,
their administration may be problematic in that individuals with ASD may have
difficulties in sustaining a reciprocal conversation, reporting events, and perspective taking. Nevertheless,
comorbid problems should be assessed whenever significant behavioral issues
(e.g., inattention, impulsivity, mood instability, anxiety, sleep disturbance,
aggression) become evident or when major changes in behavior are reported. Individuals who are
nonverbal or have language deficits, observable symptoms such as changes in sleeping
or eating or increases in challenging behavior should be evaluated for anxiety
and depression. Co-occurring conditions should also be carefully investigated when severe or
worsening symptoms are present that are not responding to intervention or
treatment.Further information on best practice guidelines for assessment and intervention is available from A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Saturday, April 4, 2020

There has been a dramatic
worldwide increase in reported cases of autism over the past decade. Yet, compared to population estimates, identification rates have
not kept pace in our schools. It is not unusual for children with less severe
symptoms of ASD to go unidentified until well after entering school. As a
result, it is critical that school-based support personnel (e.g., school psychologists, special educators, school counselors, speech/language pathologists, and social
workers) give greater priority to case finding and screening to
ensure that children with ASD are identified and have access to the appropriate programs and services.

Screening and Identification

Until recently, there were
few validated screening measures available to assist school professionals in
the identification of students with the core ASD-related behaviors. However,
our knowledge base is expanding rapidly and we now have reliable and valid
tools to screen and evaluate children more efficiently and with greater
accuracy. The following tools have demonstrated utility in screening for ASD in
educational settings and can be used to determine which children are likely to
require further assessment and/or who might benefit from additional support.
All measures have sound psychometric properties,
are appropriate for school-age children, and time efficient (10 to 20 minutes
to complete). Training needs are minimal and require little or no professional
instruction to complete. However, interpretation of results requires
familiarity with ASD and experience in administering, scoring, and interpreting
psychological tests.

The Autism Spectrum Rating Scales (ASRS;
Goldstein & Naglieri, 2009) is a norm-referenced tool designed to
effectively identify symptoms, behaviors, and associated features of ASD in
children and adolescents from 2
to 18 years of age. The ASRS can be completed by teachers and/or parents and
has both long and short forms. The Short form was developed for screening
purposes and contains 15 items from the full-length form that have been shown
to differentiate children diagnosed with ASD from children in the general
population. High scores indicate that many behaviors associated with ASD have
been observed and follow-up recommended.

The Social Communication Questionnaire(SCQ; Rutter,
Bailey, & Lord, 2003), previously known as the Autism Screening
Questionnaire (ASQ), is a parent/caregiver dimensional measure of ASD
symptomatology appropriate for children of any chronological age older than
four years. It is available in two forms, Lifetime and Current, each with 40
questions. Scores on the questionnaire provide a reasonable index of symptom
severity in the reciprocal social interaction, communication, and
restricted/repetitive behavior domains and indicate the likelihood that a child
has an ASD.

The lifetime version is recommended for screening
purposes as it demonstrates the highest sensitivity value.

The Social Responsiveness Scale, Second Edition(SRS-2; Constantino & Gruber, 2012)
is a brief quantitative measure of autistic behaviors in 4 to 18 year old
children and youth. This 65-item rating scale was designed to be completed by
an adult (teacher and/or parent) who is familiar with the child’s current
behavior and developmental history. The SRS items measure the ASD symptoms in
the domains of social awareness, social information processing, reciprocal
social communication, social anxiety/avoidance, and stereotypic
behavior/restricted interests. The scale provides a Total Score that reflects
the level of severity across the entire autism spectrum.

A Multi-Tier Screening
Strategy

The ASRS, SCQ,
and SRS-2 can be used confidently as efficient first-level screening
tools for identifying the presence of the more broadly defined and subtle
symptoms of higher-functioning ASD in school settings. School-based
professionals should consider the following multi-step strategy for identifying
at-risk students who are in need of an in-depth assessment.

Tier one. The initial step is case finding.
This involves the ability to recognize the risk factors and/or warning signs of
ASD. All school professionals should be engaged in case finding and be alert to
those students who display atypical social and/or communication behaviors that
might be associated with ASD. Parent and/or teacher reports of social
impairment combined with communication and behavioral concerns constitute a
“red flag” and indicate the need for screening. Students who are identified
with risk factors during the case finding phase should be referred for formal
screening.

Tier two. Scores on the ASRS, SCQ,
and SRS-2 may be used as an indication of the approximate severity of
ASD symptomatology for students who present with elevated developmental risk
factors and/or warning signs of ASD. Screening results are shared with parents
and school-based teams with a focus on intervention planning and ongoing
observation. Scores can also be used for progress monitoring and to measure
change over time. Students with a positive screen who continue to show minimal
progress at this level are then considered for a more comprehensive assessment
and intensive interventions as part of Tier 3.
However, as with all screening tools, there will be some false negatives
(children with ASD who are not identified). Thus, children who screen negative,
but who have a high level of risk and/or where parent and/or teacher concerns
indicate developmental variations and behaviors consistent with an
autism-related disorder should continue to be monitored, regardless of
screening results.

Tier three. Students who
meet the threshold criteria in step two may then referred for an in-depth
assessment. Because the ASRS, SCQ, and SRS-2 are strongly
related to well-established and researched gold standard measures and report high
levels of sensitivity (ability to correctly identify cases in a population),
the results from these screening measures can be used in combination with a
comprehensive developmental assessment of social behavior, language and
communication, adaptive behavior, motor skills, sensory issues, and cognitive
functioning to aid in determining eligibility for special education services
and as a guide to intervention planning.

Limitations

Although the ASRS, SCQ, and SRS can be used
confidently as efficient screening tools for identifying children across the
broad autism spectrum, they are not without limitations. Some students who
screen positive will not be identified with an ASD (false positive). On the
other hand, some children who were not initially identified will go on to meet
the diagnostic and/or classification criteria (false negative). Therefore, it
is especially important to carefully monitor those students who screen negative
to ensure access to intervention services if needed. Gathering information from
family and school resources during screening will also facilitate
identification of possible cases. Autism specific tools are not currently
recommended for the universal screening of typical school-age children. Focusing
on referred children with identified risk-factors and/or developmental delays
will increase predictive values and result in more efficient identification
efforts.

Concluding Comments

Compared with general
population estimates, children with mild autistic traits appear to be an
underidentified and underserved population in our schools. There are likely a
substantial number of children with equivalent profiles to those with a
clinical diagnosis of ASD who are not receiving services. Research indicates that
outcomes for children on the autism spectrum can be significantly enhanced with
the delivery of intensive intervention services. However, intervention services can only be implemented if students are
identified. Screening is the initial step in this process. School professionals
should be prepared to recognize the presence of risk factors and/or early
warning signs of ASD, engage in case finding, and be familiar with screening
tools in order to ensure children with ASD are being identified and provided
with the appropriate programs and services.

Thursday, March 19, 2020

The coronavirus, or COVID-19, may cause fear, anxiety, or confusion for many children and youth. While Social Narratives have been shown to be an effective strategy for children with autism, they are appropriate for individuals of any age who may be experiencing challenges with social communication. Social Narratives can help alleviate fears and anxiety many children may be experiencing at this time and help them cope during the coming days and weeks.

Wednesday, March 4, 2020

The problem behaviors of
children on the autism spectrum (ASD) are among the most challenging
and stressful issues faced by many schools and parents. The current best practice in
treating and preventing undesirable or challenging behaviors utilizes the principles
and practices of positive behavior support (PBS). PBS is not a specific
intervention per se, but rather a set of research-based strategies that are
intended to decrease problem behaviors by designing effective environments and
teaching students appropriate social and communication skills. PBS utilizes primary (school-wide), secondary (targeted group), and tertiary (individual) levels or tiers of intervention, with each tier providing an increasing level of intensity and support.

PBS Strategies in the Classroom

Other than families,
teachers are the most influential resource for students with and without special needs. Although functional behavior assessment (FBA) and intensive individual support is recommended for students with serious and persistent challenging behaviors, teachers may prevent the possibility of problematic behavior through the implementation of class-wide and targeted group PBS strategies. For example, effective prevention of challenging social behavior can be
addressed through arranging the classroom environment and/or by adapting
instruction and the curriculum. Changing the classroom environment or
instruction may lessen the triggers or events that set off the challenging
behavior. Teaching effective social interaction and communication as
replacements for challenging behavior is also a preventive strategy for
improving little used student social interaction and communication skills.
Teachers can model, demonstrate, coach, or role-play the appropriate
interaction skills. They can teach students to ask for help during difficult
activities or negotiate alternative times to finish work. Encouraging positive
social interactions such as conversational skills will help students with
challenging behavior to effectively obtain positive peer attention. The
following are examples of PBS strategies for improving social skills and
prosocial behaviors in the classroom (Vaughn, Duchnowski, Sheffield, &
Kutash, 2005; Wilkinson, 2017).

Initiating interactions. Teachers
might notice that when a student with autism enters the classroom, group activity,
or other social interaction, they may have particular difficulty greeting
others students or starting a conversation. For example, they may joke, call
another student a name, laugh, or say something inappropriate. In this
situation, the student may have trouble initiating interactions or
conversations. The teacher might talk to the student individually and offer
suggestions for ways he or she can provide an appropriate greeting or introduce
a topic of conversation. The student might then be asked to practice or
role-play the desired behavior.

Example:“why don’t you
ask students what they did last night, tell them about a TV show you watched,
or ask if they finished their homework, rather than shouting or saying ‘Hey,
Stupid.’ Other students in the class want to be your friend, but you make it
difficult for them to talk with you. Let’s practice the next time the class
begins a new group activity.”

Maintaining interactions. Many autistic students struggle to maintain a conversation (e.g.., turn taking).
Some may dominate the conversation and make others feel that they have nothing
to contribute, while other students may experience difficulty keeping up with
the flow of conversation and asking questions. Students may also have limited
topics of interest and discuss these topics repetitively.

Example: “I’ve noticed that
other students cannot share their thoughts and ideas with you when you start a
conversation because you do all the talking. It may seem to them that you don’t
care what they have to say. Other students will be more willing to talk if you
stop once you’ve stated your idea or opinion and allow them a turn to talk.
When you stop, they know you are listening. You can say to them, “What do you
think?” or “Has this ever happened to you?’”

Terminating interactions. Some
students with autism may not know how to appropriately end a conversation. They
may abruptly walk away, start talking with another student, or bluntly tell a
student they don’t know what they’re talking about. Other students may
interpret this as rude and impolite behavior. Teachers might point out to the
student some ac­ceptable ways of ending a conversation.

Example: “You just walked
away from that student when they were talking. Rather than walk away, you might
say “‘I have to go now,’ ‘It’s time for my next class,’ ‘Or ‘I’ll see you later
and we can finish our talk.’”

Recognizing body language.
The recognition of body language or nonverbal cues is critical to successful
social interactions. Autistic students typically have difficulty interpreting
these cues from teachers or other students. Body language tells students when
they violate a person’s personal space, a person needs to leave, or they need
to change behavior. Teachers can incorporate these skills into their class time
or school day.

Example:Before leaving
the classroom, demonstrate nonverbal cues by holding a finger to your
lips and telling students that means “quiet,” a hand held up with palm facing outward means “wait” or “stop,” and both hands pushing downward means “slow
down.” You may need to demonstrate facial expressions you use to “deliver
messages” and what they mean. Other students can demonstrate nonverbal cues
they use. When students move through the halls, you may want to teach them the
“arms length” rule for personal space.

Transitions. Many students
with autism have significant problems changing from one activity to the next or
moving from one location to another. They may be easily upset by abrupt changes
in routine and unable to estimate how much time is left to finish an activity
and begin the next one. Poor executive function skills such as disorganization
may also prevent them from putting materials away from the last activity or
getting ready for the next activity. They may also need closure and preparation
time for the transition. Problems arise if the teacher tries to push them to
transition at the last minute.

Example:About 10 minutes
prior to the transition, refer to the classroom schedule and announce when the
bell will ring or when the next activity will begin. Provide a 5-minute and
then a 1-minute warning. This countdown helps students finish assignments or
end favorite activities. For students that have difficulty getting started
after a transition, place assign­ment folders on their desks so that they have
their assignments and don’t have to wait for instructions or materials. They
can use the same folder to submit assignments (the folders can be left on their
desks at the end of the period).

Conclusion

Students on the autism spectrum often
lack the social skills to communicate and interact effectively with peers and
adults. They may use challenging or disruptive behavior to communicate their
needs. These examples illustrate how PBS provides a proactive framework for
assessing social interaction and communication needs and for teaching new,
effective skills that replace the challenging behavior. When used consistently,
these strategies fit within the framework of the classroom and can help promote
positive student behavior.

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The objective of bestpracticeautism.com is to advocate, educate, and informby providing a best practice guide to the screening, assessment, and intervention for school-age children on the autism spectrum. Timely articles and postings include topics such as screening, evaluation, positive behavior support (PBS), self-management, educational planning, IEP development, gender differences, evidence-based interventions (EBI) and more. This site also features up-to-date information on scientifically validated treatment options for children with ASD and a list of best practice books, articles, and links to organizations. Designed to be a practical and useful resource, bestpracticeautism.com offers essential information for psychologists, teachers, counselors, advocates and attorneys, special education professionals, and parents.

Best Practice Guide

Praise for "A Best Practice Guide..."

“It is rare that one book can pack so many resources and easy to digest information into a single volume! Families, school personnel, and professionals all need the extensive, and up-to-date tips, guides, and ‘must-knows’ provided here. It’s obvious the author is both a seasoned researcher and practitioner – a winning combination.” - Dr. Debra Moore, psychologist and co-author with Dr. Temple Grandin, of The Loving Push: How Parents & Professionals Can Help Spectrum Kids Become Successful Adult

“Dr Wilkinson has done it again. This updated and scholarly Second Edition reflects important recent changes regarding diagnosis and services for students with Autism Spectrum Disorder. With its numerous best-practice suggestions, it is a must-read for school psychologists, school social workers, and those who teach in general and special education.” - Dr Steven Landau, Professor of School Psychology in the Department of Psychology, Illinois State University

“This book is an essential resource for every educator that works with students with ASD! The easy-to-read format is complete with up to date research on evidence-based practices for this population, sample observation and assessment worksheets and case studies that allow the reader to apply the information presented.” - Gena P. Barnhill, PhD, NCSP, BCBA-D, LBA, Director of Special Education Programs at Lynchburg College, Lynchburg, VA

Continuing Education (CE/CEU) Credit

Best Practice Autism Podcast

The Thrive with Apergers Podcast: Ovrecoming Anxiety and Depression on the Autism Spectrum

Disclaimer

BESTPRACTICEAUTISM.COM DOES NOT ENDORSE ANY TREATMENT, MEDICATIONS, OR THERAPIES FOR AUTISM. THE WRITTEN MATERIALS CONTAINED ON THIS SITE ARE FOR INFORMATIONAL PURPOSES ONLY.